Characteristics of the community health agent’s work in the COVID-19 pandemic in municipalities of Northeastern Brazil

França, Camila de Jesus; Nunes, Cristiane Abdon; Vilasbôas, Ana Luiza Queiroz; Aleluia, Ítalo Ricardo Santos; Aquino, Rosana; Nunes, Fabiely Gomes da Silva; Prado, Nilia Maria de Brito Lima

doi:10.1590/1413-81232023285.18422022EN

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ARTICLE • Ciênc. saúde coletiva 28 (05) • May 2023 • https://doi.org/10.1590/1413-81232023285.18422022EN copy

Characteristics of the community health agent’s work in the COVID-19 pandemic in municipalities of Northeastern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The community health agents (CHAs) comprised the workforce at the forefront of health systems in the fight against COVID-19. The study identified the structural conditions for organizing and characterizing the work of CHAs in three municipalities of northeastern Brazil during the pandemic period. A qualitative study of multiple cases was carried out. Twenty-eight subjects were interviewed, including community agents and municipal managers. Data production assessed the interviews with document analysis. The operational categories that emerged from the data analysis were: structural conditions and characteristics of the activities. The results of this study disclosed the scarcity of the structural conditions in the health units, which during the pandemic made improvised adaptations of the internal spaces. As for the work characteristics, actions permeated by bureaucratic aspects of an administrative nature were evidenced in the health units, resulting in the elimination of their binding function of territorial articulation and community mobilization. Thus, changes in their work can be seen as signs of the fragility of the health system and, especially, of primary health care.

Key words:
Primary health care; Community health workers; Community orientation; COVID-19

Place	Level of evidence	Dimensions of work organization
		Structural conditions	Characteristics of the activities
		Structural conditions	Internal activities at the services/USF	Community activities
Primary Health Care Secretariats (SAPS)	Recommendations for adapting the actions of Community Health Agents to the current epidemiological situation regarding Covid-19.	. Perform frequent hand washing with soap and water or alcohol gel. . Keep environments well ventilated. . Use a surgical mask and ensure the use of appropriate PPE. . Use disposable tissue paper for nasal hygiene. . Guide and assist in monitoring - preferably by telephone.	. Organize embracement; . Monitoring of suspected and confirmed cases. . Educational activities in the unit; . Identification of suspected cases; . Working at the Unit (CHAs over 60 years old and/or with chronic conditions). . Assist in user service through fast-track.	. Carry out an active search for new suspected cases of flu syndrome and risk group for influenza vaccination. . Health promotion and prevention guidelines. . Assist in vaccination activities. . Peridomiciliary visit (Prioritize risk groups).
Primary Health Care Secretariats (SAPS)	General guidelines on the CHA's work in the face of the Covid-19 pandemic and records to be carried out in the e-SUS PHC.	. Maintain distance from the patient - if not possible, use a surgical mask. . Sanitize hands using alcohol gel. . Wear a mask and ensure the use of PPE.	. Record of the home visit form and the individual registration form in loco.	. The visit will be limited to the peridomiciliary area only and prioritize patients at risk.
M1	Technical Notes: . N. 01/2020, of 03/19/20. . N. 002/2020, of 03/25/2020. . N. 05/2020, of 04/09/2020.	. Use of masks when visiting a patient in isolation at home. . Use PPE when necessary and preventive measures, especially during home visits.	. Assist in the management of supplies and equipment necessary for the performance of COVID-19 care activities.	. Will perform activities of monitoring, guidance, active search, identification of suspected cases at the households. . Develop intersectoral actions.
M1	Technical Note DAS/APS-New Coronavirus. N. 009/2020, of June/2020.	. Tablet for patient registration - text messaging application, by using a specific chip for this purpose. . Use of communication channels . Use of surgical masks and hand hygiene with water, soap and 70% alcohol.	. Carry out tele-registration. . Carry out most of the workload inside the health unit. . Respond to messages, in addition to embracement and active search using remote means. . Organizing, directing and guiding - BHU ordinance. . Triage and guidance; . Carry out visits (priority group).	. In the territory, actions restricted to the active search of users at greater risk and vulnerability. . Peridomiciliary visits (prioritize risk group) . Communication with community leaders. . Guidelines; . Identification of social vulnerabilities.
M2	New Coronavirus Municipal Contingency Plan (03/18/2020, updated on 06/2020)	Adequate use of PPE and preventive biosafety measures.	. Help in the management of necessary supplies and equipment.	. Acompanhamento domiciliar. Realizar orientações.
	Nota Técnica 01/2020.	. Adequate use of PPE, specifically when there are suspected cases.	. Assist in care based on training to apply the FAST-TRACK, prepared by the Ministry of Health, to identify suspected cases.	. Deverão realizar as visitas não adentrando no domicílio, ao ar livre, priorizando grupo de risco.
	Technical Note issued in July/2021.	. Use of mask during visits and activities during working hours.	. Typing the notification form. . Delivery of exams and procedures.	. Carry out peridomiciliary visits, prioritizing the population at risk; . Notification and monitoring. . Monitoring- risk groups.
M3	Municipal Contingency Plan (03/2020)	. No description regarding the structural conditions	. No description regarding the CHA’s work	. No description regarding the CHA’s work

CHA’S work
Analytical category	Operational category	Description	Central aspects for analysis	Evidence	Script questions
Working means/conditions	Organization of work and unit (structural and material conditions)	They are related to physical conditions and facilities and physical and/or material security conditions; tools and physical structures for work, such as equipment, instruments, establishments and the environment.	BHU physical structure - protocols for work organization	Interview with Manager of Services Primary Care (SPC)	Has the municipal coordination of SPC created or adopted protocols to face the pandemic? (CHA’s work)
			BHU physical structure - protocols for work organization	Interview with Manager of Services Primary Care (SPC)	What were the actions developed by the municipal coordination of SPC to support the surveillance actions carried out by the SPC teams? Notification of cases, guidelines and educational actions, testing?
			Physical structure of the BHU (rooms, locations/environments adequate for the internal support of activities)	Interview with CHA	Did your unit undergo any type of change or adaptation in the physical environment due to the pandemic? Which?
			Availability of hygiene materials and PPE (quantity and type)	Interview with CHA	In the context of the pandemic, what hygiene measures were adopted in your workplace? Are they adequate?
				Interview with CHA	Is PPE available for carrying out your work at the unit? Which? Are they adequate and sufficient? Were they made available from the beginning?
			Availability of electronic equipment (cell phone, tablet, computer, landline); Internet access	Interview with CHA	During the pandemic, was electronic equipment purchased in your unit to establish contact with users?
					Do you use your personal cell phone to contact users? How often?
					Does your unit have internet access? Has connectivity improved?
Working means/conditions	Organization of work and unit (Structural and material conditions)	They are related to physical conditions and facilities and physical and/or material security conditions; tools and physical structures for work, such as equipment, instruments, establishments and the environment.	Qualifications and suitability information	Interview with CHA	Have you participated in qualification or training on COVID-19? If so, what topics were covered?
Working means/conditions			Qualifications and suitability information	Interview with CHA	Is there a source of information about COVID-19 in your workplace that guides actions? What is the source of information? How do you evaluate the information received in your workplace?
Work itself (performed activities)	Characteristics of activities related to the work of CHAs	Related to the content of work activities, the organization and division of work, the ways in which workers carry out their activities.	Content of CHA activities	Interview with CHA	During the COVID-19 pandemic, were there changes in the organization of the work process?
					What were the modified activities?
					Do you consider that the adaptations of your unit's work process were sufficient for the performance of your work activities safely in the context of COVID-19?
					Regarding the home visit by the community health agent for users monitored at the unit, how is it working at the moment?
			Organization and division of work and ways of working (changes in routines and collaboration in teams)	Interview with CHA	Have there been any changes to your work routine during the pandemic? What were these changes?

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva